Lieberman, Akaka Ask Administration for Details on U.S. Preparedness for Flu Pandemic

FOR IMMEDIATE RELEASE WASHINGTON – Senate Homeland Security and Governmental Affairs Committee Ranking Member Joe Lieberman (D-CT), and Oversight of Government Management Subcommittee Ranking Member Daniel Akaka (D-HI) today expressed serious concerns that the Bush Administration may be inadequately prepared for a potential avian flu pandemic or other public health disaster in the U.S. In a letter to Department of Health and Human Services Secretary Michael Leavitt the Senators asked for answers to a number of specific questions on U.S. preparedness. The letter is below and attached.

January 13, 2006

Secretary Michael Leavitt Department of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C. 20201

Dear Secretary Leavitt,

As Secretary of the Department of Health and Human Services (DHHS) you play a critical role in assessing medical disaster response needs and responding to those needs. Many Americans are concerned by the growing spread of the H5N1 avian influenza virus and I know you share this concern. The virus, which originated in Southeast Asia, has now moved to Mongolia, across to Romania and the EU, and now to Africa. The H5N1 avian flu strain has killed over 60 people. However, the strain with the right mutation can kill millions. Because of the very serious medical response difficulties we witnessed in the preparation for and aftermath of Hurricane Katrina, public concerns about a potential avian flu epidemic must be addressed. Many people are worried that we are inadequately prepared for a potential pandemic and others in the future. The Katrina failures must not be repeated. Therefore, as the Ranking Member of the Senate’s major oversight committee with jurisdiction over government organization, I have compiled a list of questions and request your response as we prepare for a possible flu pandemic. Planning & Coordination The key to adequate and appropriate medical response is planning. As we examine who is in charge of coordinating national medical response to disasters, it is not clear. The Homeland Security Act of 2002 transferred some command and control and disaster medical assets to the Department of Homeland Security (DHS), but significant public health and programmatic responsibilities, statutory authority, and medical expertise are retained by DHHS. Therefore, we need a clearer idea of how medical response is coordinated and what DHHS is specifically responsible for in the event of a public health event or emergency, including the responsibilities of DHHS under the ESF#8 of the National Response Plan, which gives command and control to DHHS to coordinate public health and medical services regarding national disasters. 1) Which agency will be ultimately accountable – DHS or DHHS – for coordinating human medical response in the event of an avian flu epidemic? 2) How will DHHS implement public health and medical response plans with command and control and disaster medical assets retained by DHS? How will DHHS implement ESF#8? Which particular person will be in charge at DHHS for a public health event and specifically for ESF#8? 3) Please describe what each of the operating divisions of DHHS are doing to prepare for a possible pandemic, including: the Office of Public Health and Emergency Preparedness (OPHEP), Centers for Disease Control and Prevention (CDC), Health Resources and Services Administration (HRSA), Substance Abuse and Mental Health Services Administration (SAMHSA), the Surgeon General’s Office, the Food and Drug Administration (FDA), the Indian Health Services (IHS), the National Institutes of Health (NIH), the Administration for Children and Families (ACF), and the Administration on Aging (AoA)? What resources, including financial, are being given to each for preparation? What is the operating coordination mechanism to both assure day-to-day and overall planning coordination between these entities? 4) The President’s avian flu plan was recently released. How is DHHS incorporating the President’s plan into its own? What mechanisms are in place to ensure that DHHS and DHS through the National Response Plan (NRP) are communicating and working together fluidly in the event of a pandemic flu? 5) How will DHHS provide public health information for different populations with different degrees of exposure and resources in their communities? For instance, if there is an outbreak in New York City, people in Washington DC may panic and try to obtain limited supplies of antivirals that should be reserved for priority groups and those in the immediate vicinity of the outbreak. How will DHHS work with other federal agencies to help people understand their level of risk and take appropriate measures? 6) Preventing and preparing for an epidemic are contingent on predicting where disease outbreaks are likely to occur. Wild migratory birds are spreading H5N1; therefore, tracking them internationally has direct implications for disease prevention and preparedness. How is DHHS addressing global wild bird surveillance? Are agencies systematically examining international testing and surveillance data to track viral mutations as H5N1 moves across the globe? Emergency Response There is increasing attention on our medical system’s current capacity to respond to a pandemic. Numerous questions, such as distributing drugs, medical supplies, and food and water, and supporting healthcare providers flooded with patients require planning prior to the onset of an emergency. However, it is unclear what plans are in place to coordinate these efforts. 7) Has a cross-agency communications working group been established, as outlined in the DHHS pandemic flu plan? If so, what are the products, to date and in preparation, of the working group and which agencies and officials have been included? 8) The DHHS pandemic flu plan states that the “Federal government may mobilize the PHS Commissioned Corps to distribute vaccines or medications” to Federal agencies, states, and localities throughout the National Disaster Medical System (NDMS). How will federally stockpiled vaccines and antivirals be delivered? For example, will already stretched private distribution mechanisms with limited backup supply be used or will untested public distribution mechanisms be used? How will DHHS coordinate with DHS when supply chain, delivery, and labor shortages occur? Have private and public partnerships been explored in this area, and if so, what processes are in place? 9) DHHS has outlined priority groups for vaccines and antivirals. Exactly, how will we ensure that people adhere to the priority list? How will public health and medical workers be trained to cope with panicked citizens not in priority groups asking for treatments? 10) What specific programmatic supports and funding will hospitals receive to manage people that will be flooding hospitals in the event of a pandemic? Are there estimates for the numbers of health professionals required during a flu pandemic occurring in multiple waves with varying levels of pathogenicity and lethality? Please provide these. How will these individuals be mobilized and transported in urban and rural areas as needed? 11) What provisions will be made for individuals that require medical attention for non-flu related illnesses, such as diabetes, stroke, or heart disease? What plans are there and how will the government help hospitals implement plans? 12) Who in the federal government and in the states will decide when and how to implement human containment measures, such as quarantines, canceling public gatherings, or advising non-essential workers to remain at home? How has DHHS been involved, other than through financial assistance, in setting guidelines to support decision-making on the state and local levels? Medical Preparedness It is impossible to predict the nature of any disaster. However, we must be prepared for the contingencies that can be anticipated. We know that hospital surge capacity will be a problem. Hospitals have not systematically trained in disaster preparedness and are not involved in preparedness planning efforts. DHHS will be the lead in mapping out a plan for trauma preparedness, ordering the implementation of the plan, monitoring progress, and responding to emerging needs. 13) If there is a pandemic flu outbreak, many health workers may not put themselves at risk or may be unable to work due to early exposure. What communications systems are in place between local hospitals, state agencies, and DHHS to ensure that any outbreak is met with an immediate supply of antivirals and vaccines for priority groups? 14) Hospitals are often running to capacity during annual flu seasons, indicating limited surge capacity. Providers and experts have stated that our current medical system is not be equipped to address the health needs of communities due to an influenza pandemic. How many mobile hospital units are being considered to enhance capacity, even though they were not included in the DHHS pandemic flu plan? How will mobile hospital units be staffed given that healthcare workers will remain in hospitals and clinics? How will mobile hospital units be supplied – via private and/or public distribution systems? Where would they be established? How will DHS be involved in efforts to set up mobile or temporary units? What role will the US military medical system play? 15) “Critical product continuity” refers to ensuring that important goods in a time of pandemic, such as syringes, masks, and IV bags, are in supply. Our current stocks of critical medical supplies are insufficient and will require a surge capacity in both manufacturing and transport. Has the private sector been consulted in ensuring the continuous supply of critical products and what plans have resulted from discussions? 16) How will medical expenses for the uninsured, beneficiaries of entitlement programs, and other victims of a pandemic be covered? Have mechanisms other than Medicaid been identified for providing coverage? There was no mention in the DHHS pandemic flu plan regarding coverage for non-Medicaid populations. Are there estimates for the number of people that may require additional coverage if there is a pandemic in the US? 17) The potential for a human pandemic will require significant psychosocial support services to children, families, and communities. Please describe your plans to screen for mental health, related substance abuse, and family support needs. What mechanisms are being considered to provide the requisite services? How will services be reimbursed? 18) DHHS has published extensive guidelines for the roles and responsibilities of healthcare and public health providers in the event of a pandemic. Despite the guidelines, many hospitals are not involved in planning efforts to the extent necessary for disasters and pandemics due to lack of funding. Are there plans to reimburse hospitals for preparedness planning or provide other incentives? 19) The psychological impact and response of not having sufficient medical solutions or treatments will be significant. People may have panic responses and not be able to accurately assess their level of risk or non-medical measures they can take to minimize their risk. People will feel that medication or a “silver bullet” will be their only option to survive successive waves of a pandemic. Specifically, how are communications working groups addressing these issues? What are their plans for public education and outreach? 20) Overall, the DHHS plan is detailed and addresses a number of major areas of concern. However, the report is not specific in how states and localities should carry out the recommendations. Many experts have suggested that a single public health and medical response plan and strategy, including for ESF #8, across all 50 states is necessary to successfully fight a pandemic. Are you going to more clearly outline a single strategy, and if so, when will that be available? Avian flu may never strike the United States, but if it does, this country must be prepared. I thank you for your thoughtful consideration of these complex and pressing issues. I would like to work with you coordinating your efforts with those of other agencies and levels of government to ensure the safety of Americans in a worst case disaster scenario. Sincerely, Senator Joseph I. Lieberman Senator Daniel Akaka Ranking Member Ranking Member Committee on Governmental Affairs and Subcommittee on Government Homeland Security Management, the Federal workforce and the District of Columbia